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Sunday, October 17, 2010

My Experience with Infertility

Susan Sarandon had a child with Tim Robbins at age 46.

You might ask why I know such a thing. Believe me, I'm not some kind of encyclopedia of what celebrities had kids at what ages. But in 1992, when Susan Sarandon was 46 and give birth to a son, my mother was 42 and trying to get pregnant for the last three years.

I don't know if you've ever known someone having problems with infertility. Or if you have, you may not have lived with them. It's pretty painful. When my mother found out Susan Sarandon was pregnant, she cried. Cried! Let me tell you, there are a lot of people in this world procreating... probably, like, millions... and it's really difficult to shield your mother from all of them. We weren't even allowed to watch television shows involving fictional pregnancies or babies.

It went on for years. Years of pregnancy tests, ovulation kits, fertility drugs, and mostly just a lot of crying. And eventually, she really was too old and then there was the "trying to adopt" era, which came with its own set of heartbreaks.

I had my daughter when I was 27 and was probably the youngest of all my friends and colleagues to have a baby. Although interestingly, that was still above the average age to have a first child in this country. But then again, that includes people living in huts in Wyoming, where I don't think birth control has been invented yet. (Kidding!) In any case, I felt a little awkward at times having a baby so early. Some of my friends thought I was nuts. And now, almost four years later, some of them STILL haven't gotten started on their first.

The thing is, when you've watched someone so close to you go through the heartbreak of infertility month after month, it's really hard to wait for something you know you really want. I knew I had to be a mother, that my life would seem empty if I didn't get to experience that, so how could I do anything to risk that not happening? And I did wait for quite a while. It's not like I got knocked up in high school... I made it through my entire intern year.

That's why I feel a bit perplexed when I see my female friends waiting through all of med school then all of residency, and even though they're married and in their early or even mid thirties, they still continue to wait. And the truth is, I'm sure they're all going to get pregnant. People seem to get pregnant pretty easily. But then again, what if you're the one person who can't and you didn't even start trying till age 35? I had a talk about this with an OB/GYN attending and she said that most of her female co-residents decided to wait until after residency to conceive and some were less successful than others.

That's why, despite the fact that I'm only 31 and in many ways I like my life how it is, I feel compelled to start thinking about having a second baby sooner rather than later. My husband tells me I'm being silly, but if I know I want a second, then how could I risk not having it?

Note: This is my 100th post on MiM. Definitely a sign I've got too much time on my hands.

43 comments:

Fizzy,Although I appreciate your comments on fertility, I felt compelled to respond. I am a 30 year old female with 1 year and 8 months (who's counting?) left of residency. My husband and I are both in residency training actually and although I do think we will want children in the future, we are not trying to get pregnant currently. Unfortunately, your unfairly written article helps contribute to the pressure that women in my position feel. As a woman in her thirties, I have had friends, family and even patients give me the "you better hurry up and start a family" lecture. And, as a doctor I am acutely aware that statistics are not in my favor as I gain years. However, I am a firm believer you must be mentally ready to start a family and not just start trying because you feel time is running out. Your article, especially written by a female doctor of only 31 years is not very woman friendly. In addition, when you write things like, "That's why I feel a bit perplexed when I see my female friends waiting through all of med school then all of residency, and even though they're married and in their early or even mid thirties, they still continue to wait." maybe you should take a minute to get to know these women before you make these kind of statements? Why not talk to these friends of yours if you are so concerned? As successful and intelligent female doctors we understand the risks of waiting to have children until we are ready. Although this may perplex you, not all of us are in the position to have children in medical school or residency. Finally, as a colleague, I would appreciate you thinking before judging me and female doctors that make the tough decision to wait.

Anon, I appreciate your POV. I didn't say these things to judge anyone or be controversial, although I was fairly sure that some people (especially those who are already feeling The Pressure) would take it that way. I am just trying to share the pressure that I personally felt to have a child early and why I felt that way.

Obviously, I know as well as anyone that having a baby is a HUGE deal and sometimes I do wish I had waited. A lot of the times I feel jealous of my friends who waited. But I also know from experience that infertility is really really heartbreaking and frustrating and I was terrified of going through that myself.

Ultimately, it is a risk that you take when you wait. If you're comfortable taking that risk, then great. I wasn't. And I wanted to explain why.

It's just a set of facts and judgments. Chances of infertility (and complications) go up with age. You have to judge that against your financial and personal and relationship situation, against how important having a child (or children) is to you, and make a decision based on those factors.

Easy as pie. I think I'm with Fizzy too, for the most part. I got married at 28 and we decided to give it a try right away, though we didn't feel ready- when DO you really feel ready, though? I put "giving myself the best shot at fertility possible" ahead of "feeling totally ready" on the priority scale. Fair or not, it's medical facts, and I don't know if I ever WOULD have felt really ready.

(As it turned out, infertility wasn't a problem for us at all. Still glad we made that decision, though, because we liked having kids more than we expected to, wanted more than we originally expected to, and this way I was still able to have three kids before ever coming close to an age where my OB would worry.)

Also, I should add that this post (not article) is more of a defense of my somewhat controversial experience NOT to wait, since that seems to be the more mainstream choice in my circles, than it is an ominous warning to those who don't. We all judge each other, like it or not, and I was judged for that decision. I wanted to explain to anyone curious why I did things that way.

I think that the "when to have your baby" question in its many iterations is one of the hardest to answer for many women in medicine.

The real answer? There's never really a good time; you just have to go for it when you're young, poor and busy or hold out until you're richer, older, have more time and an increased chance of infertility.

What's perplexing to me if why this is so hard for you to fathom, Fizzy. Not every woman lives her life waiting for that day when she can finally be a mother. You're entitled to your set of priorities, other women are entitled to theirs.

Some people seem to be having trouble with the word "perplexed," so why don't we say "curious" instead?

And I do, of course, understand the decision to wait on some level, because I've been waiting on number 2. Most people have their kids 2-3 years apart and I've waited longer. I'm sure many people are perplexed as to why I've waited longer, and I'm okay with that. I'm comfortable with my decision and the risk I'm taking.

I have lots of friends who don't want kids at all and that's pretty understandable. I guess I'm more "curious" about friends who are 35+ and definitely want kids, but are still waiting. It seems like a big risk, but then again, I am extremely risk adverse in general. I hate to gamble.

Once again, I didn't intend this as a judgmental post, although I'm not surprised or disappointed it sparked some controversy. My mother's infertility was a primary theme during at least a third of my childhood. I was sharing a meaningful story that influenced my later choices. I was trying to be honest and share my feelings. Waiting to conceive is a risk, that is a fact. I was trying to explain why I didn't want to take that risk.

Fizzy, I don't think it's that horrible of a thing to have a kid early. And 27 isn't early in my book. :D I had my first when I was 20. Yep I'm probably helping skew those statistics. I couldn't be more grateful for having a child so young. When I get in med school, she'll be in school of her own, so the day care cost will be down. and I was physically able to recover so quickly, I was up and jumping around 3 days later feeling good as new (well minus tired). I love that when my child will be 18, I'll only be 38. I'll still have plenty of youthful years left to enjoy life and explore the country, and then I'll actually have the money and the common sense to do it. I too am perplexed why other women would put it off. It's so much fun and pure joy, why put that off? Why wait until your going to be too old to get down and crawl around after them? Do you really want to be going through menopause at the same time your teaching a teenager to drive? Why limit yourself, what if you have a child past 35, and then decide you want another, it's not going to be that easy, and you've definitely limited yourself on the spacing and number of kids. (Note: my mother had her first at 28, and her last at 38, which was a complication free pregnancy, so I'm aware that you can have kids later)

Brit, there are definitely pros to having babies early... as well as cons. I'm glad I was able to space my kids out more because I started younger and I probably did bounce back faster than a 38 year old. But I also sometimes feel sad that I didn't have more couple time with my husband. If I hadn't had those early experiences with infertility, I might have waited till at least 30 to try. But of course, I'm so happy I have my daughter, so any bad experience that got me her was worth it.

I'm with Fizzy. If you want a baby and are in a stable relationship and can even remotely afford it and know you want it, why risk possible infertility by waiting?

I was 26 when I got married and we jumped right into having children. My career was unstable at the time and now I stay home. Perhaps if we'd waited I'd be a working mother, but I don't regret having kids at all. My husband was 36 when we started trying. What if we'd had fertility problems? I know men can have children longer than women, but it takes years to figure out infertility, years to keep trying, then years more to go through an adoption process. How old would he be before we got a baby if we had to adopt?

So we plunged in and had no fertility problems. I'm glad. The timing wasn't perfect, my career is on hold, but I'm so glad we went through with it.

Im with Fizzy. I'm adopted and also grew up acutely aware of my parents fertility issues. It saddens me to see her post characterized as anti woman. She isn't saying all women should have children. Just that If you KNOW you want them don't take the risk of shortchanging yourself by putting career first. As an obgyn I have seen to many women regret the choice to wait. But, I too am risk averse and we started trying on our first anniversary, I was 31. Now at 32 we have a 5 month old, so no infertility, but also no regrets.

Most recent Anon: it's good to hear the perspective of an obgyn. Actually, I remember going to my obgyn when I was 25 and I said I wasn't trying for kids yet, and he said, "What are you waiting for??"

Funny story: years after her own problems, my mother made it her mission to convince younger women to have kids earlier. She talked one of her 30 year old students into having a baby with her husband, and a year later, she got a postcard with a baby's face on it that said, "Thank you for convincing my mommy to have me!"

Another post in agreement with Fizzy. I'm 33 and have a 17 month old. We started "trying" when I was 31, a few months after getting married (but many years into our relationship), despite not feeling completely ready. It was generally lousy timing - I was pregnant during the most intense, call-heavy time of my resi-fellowship, and took 6 straight months of in-house q4 call while pretty darn pregnant. It was also during my first year of the program (after two years of pediatrics), so I'm pretty sure I got branded "the pregnant one" (aka "what was she thinking??").

But, I can tell you what I was thinking. I'd seen the MAJORITY of my 30-something year old friends struggling with infertility. I'd seen their heart-break and suffering, their relationships foundering, the years passing by while they tried and tried. I was not going to take the risk. I decided that, if we, as a couple, were ready, then I wasn't going to wait for the stars to align career-wise. And, it took us 8 months, which, by a factor of 4 or so, is less than it's taken most of my friends, was still enough to give me a taste of that fear, to experience the sorrow of months of hoping followed by disappoint. I can't imagine what years of it would do to you.

The last year and a half have been tough, but every day is better, and I love my son without reservation. He is the best part of every day. I don't regret my decision to have children "early" (from a career standpoint) at all. What is too terrible to imagine, however, is the regret of a life without knowing what it is to have children. I am so glad we didn't wait.

Anti-woman can be characterized when a professional intelligent female doctor says, "And now, almost four years later, some of them STILL haven't gotten started on their first." in reference to her friends being age 31 not getting started having children. Or, when the author writes, "That's why I feel a bit perplexed when I see my female friends waiting through all of med school then all of residency, and even though they're married and in their early or even mid thirties, they still continue to wait." If you can't understand why that is not anti-woman, I cannot help you...

To the most recent Anon (who I assume is the first Anon? Can't you give yourself a name?):

After having a night to sleep on it, I feel even more certain that my post is not judgmental in the slightest. You are still in training, so the "perplexed" statement doesn't apply to you. But yes, I meant that statement. If you are 35, done with training, married, KNOW you want kids, then what are you waiting for? Just because you are a physician, does that mean your biological clock has different rules? Is stating the biological facts of female fertility anti-woman? If so, you should send some hatemail to this site and the thousands other like it:

http://www.advancedfertility.com/age.htm

Anon, I truly hope that when you're ready to conceive, you are successful. The people who are telling you not to wait though aren't doing it because they're mean or hateful. They're simply worried about biological facts and that you will be heartbroken if you take a risk and fail.

I'm not saying that 20 year old should go out and get pregnant. I'm not saying people who don't want kids need to have them or that people who aren't sure need to have them. But fertility falls off after age 30 and much more so after age 35. If you are 31 and want 2-3 kids, you are taking a risk by not trying now.

I think you need to analyze your choices, Anon, and trying to figure out why a relatively innocent and personal post made you so enraged. Look at some of my main points: my husband thinks I'm nuts, I got pregnant earlier than any of my friends and felt awkward about it, I had a trauma early in my childhood, and "everyone gets pregnant." I said repeatedly that it was my choice. If I was judgmental of anyone, it was myself. But you somehow took it as a personal attack.

I would love to hear from a female physician who really struggled with fertility (a guest post?) and maybe they can give their thoughts on whether they think waiting into your late 30s is a good idea.

I had not considered college until my first child was 5 months old (I was 22). We decided that it would be the right thing to do for me to pursue both tracks simultaneously. So I have been using my brain and my uterus non-stop for the past 9 years. Four kids and a degree and a half later, I am very happy with this decision. It is a hard thing to choose to pit career against potential risks of waiting, and thank G-d I have an awesome husband that made it possible to do both.

I do agree that there is never a good time. I use the Nike motto whenever we plan to have another child. :)

I whole heartedly agree with the sentiment of Fizzy's post and do not see it as anti women AT ALL, If anything it is encouraging to women in a very male dominated, not at all women friendly profession in which the advice is always.... "Don't have a baby in intern year" " just finish your residency", "You can't sit your exams with a baby"Then if you do decide to start a family there is little to no flexibility in work practices in your junior years. WIth more females entering medicine this HAS to change. I have struggled since graduating 39 weeks pregnant through 3 post graduate years which include another baby. I have experienced discrimination, awful comments, disbelief...It is the road less travelled amongst my colleagues which does perplex me too considering the intense desire many have for a family. IVF is a tumultuous thing for a couple to go through, Adoption is difficult, these things often become reality for female doctor

Sure every doctor doesn't have to get busy procreating, but those who want a family should feel as though they are able to do itThis is ridiculous advice coming from doctorsThe decision when to have a baby is intensely personal but as others have said no time is "the right time" The facts of infertility are just that, facts.

I remember when I was an intern in the NICU I took care of a baby whose parents had done an elective abortion years prior because they were not ready to have kids. Now that they were ready, this infant suffered a neonatal stroke and was in status epilepticus for a couple of days before the neurologist was able to break it. When he woke up, he had obvious hemi-paralysis. The parents were heartbroken.

I think the key thing here is that life is unpredictable. Our bodies are unpredictable. At the end of the day, it is a chance we're taking when we choose to wait, or not. Having a baby is a HUGE decision, and there are so many many factors to consider.

Don't feel personally attacked by Fizzy's post questioning your choices. I think she's sharing some really personal experiences that have shaped her beliefs, and hoping to start a dialogue.

Second-year medical student here, 30 yrs old, and pregnant by choice. Yes, this was a very difficult time to have a child, but I didn't want to do it later for many reasons, and the fourth year "popular time" wouldn't work for me for other reasons also personal. Residency in OB/GYN (planned) doesn't sound like it would be fun pregnant, so we went for it now before clinicals and with me giving birth before boards. I will have a weaned child before residency starts, and we are going to wait until residency is over to conceive again. I will be 36-37. Risky, but we at least will have one, and we plan on adopting one during residency. That will allow us to enlarge our family without me having to work 80 hours a week pregnant in OB/GYN residency.

Anyway - I totally agree with Fizzy's post, and I don't see it as judgemental at all. I just think that people want different things at different times. It was very important to me to be inconvenienced, and to have it harder than my classmates through giving birth during school, having no maternity leave, having no time off, and possibly testing 5-6 days post-partum than to NOT have a child at all or have one in residency. Everyone has different priorities. Maybe the "risk" is ok for some people. Maybe it isn't for others. Fizzy's worries and concerns are just as valid as the person who chose to wait, and she shouldn't be perceived as judging when she is only voicing her own personal reasons. Anybody could do a similar blog about why they waited, and they likewise shouldn't be judged as "pro-woman" for it. I am pretty sure Fizzy is also pro-woman, but as any woman is - we all have different wants, opinions, and convictions.

The spirit of the initial post, and the spirited responses following, strikes at one of the most sensitive and shockingly taboo subjects in medicine: women's reproductive rights.

This may seem like an odd connection to make, but even though abortion and infertility appear to be at the opposite ends of the spectrum, both involve a form of family planning that, up until 30 years ago, didn't exist for modern women. While the former gets most of the negative press and visceral reactions, infertility plays a more insidious role in our progressive society where women first demanded, and then were thrust, into the workplace. Surprisingly, it also tends to pit women versus women at a higher rate than the abortion debate.

I'm a Maternal-Fetal Medicine fellow and while I can try to make grand statements "from experience" or even spout more anecdotes than most about the "risks" and "dangers" of "waiting" to get pregnant, I can tell you simply as a husband and potential father at the age of 32, that the "choice" people seem to be throwing around in this forum is a fallacy. The drive to have kids and drive to become a mother are, in fact, two different things. One is based on calendars and career, the other on nature and nurture. And to complicate things more, these separate states are both interchangeable and may overlap.

I have been with my wife for nearly a decade, having gotten married two years ago during my third year of Ob-Gyn residency, just before she headed overseas to start medical school. She spent time working to support me through medical school and then getting her research career on track, making her part of the "non-traditional" applicant pool. She was clear with me up front that having a child was not a priority to her. She had a clear picture in her mind of the career path she chose and the lifestyle she hoped to lead, and a child didn't really fit well in her opinion. And to be quite honest, I was fine with that. MORE than fine. I often consider myself an overgrown kid and wonder how I could raise a child when I still need to motivate myself to eat my vegetables and stop reading comic books.

Now, as she progresses through medical school, something "clicked." I can only assume so, since that's the only way I can explain it in myself. Having a child was first posed as a biologic question (too old? doomed by genetics? miscarriage rates?) and then a financial one (student loans? childcare? family helping out? impact on careers?). We've been laying the framework now for nearly a year via Skype, in a time when we're the deepest in debt, and will be living a city on a coast with the minimum amount of familial presence or support. It makes no sense, but at the same time it does. Which lends itself to the comments some posters on this forum make about there being no such thing as a "right time".

Does age factor into this? Yes. Does career path? Yes. Financial situation? Yes. How about maternal instinct? My wife would tell you "yes" before pausing and saying "finally". Does social pressure? For us, I can honestly say no. And you're talking to the son of a classic Greek mom whose daughter has already given her twin grandchildren (through the pain/miracle of modern science, may I add). It happens when it happens, if at all, and the only people that it needs to work out for are the two people that eventually will need to give 100% of their lives to raising that new person.

Which brings me back to my original point about the emotions elicited in this post and it's responses. In my job, I sometimes help maintain pregnancies that in my heart of hearts I don't feel should even have been attempted for a variety of reasons....age, health status, fetal status, prior reproductive outcomes, extreme risk for prematurity. The "miracle" of IVF has an underbelly few appreciate and are rarely depicted in advertising or on TLC's Baby Stories. I also terminate pregnancies that I know other parents would have been willing to carry despite risks. I have plenty of examples that I can use to try and convince women to have babies "sooner rather than later" or simply adopt or use a surrogate. I can also offer stories of success and hopes in the face of infertility to spur on my and my wife's choice to wait and inspire those of you out there who are hitting 30 and are childless.

But I won't do either.

I will provide answers if asked or advice if sought, but my personal beliefs remain neutral in this realm because, much like the decision to terminate, the decision to get pregnant is equally personal and can be just as painful.

Fizzy, you attempted to recant the tone of your post by changing "perplexed" to "curious," but still you're perplexed by the negative responses you've received. You shouldn't be. It's quite simple. You offered a personal anecdote as evidence, revealed that you essentially judge women for waiting, and then presented your good fortune as gospel for the joy of motherhood. I give you credit for speaking on a subject that stirs the pot and pokes at the underbelly of the modern feminism, but you have to be ready for some backlash. You may not have meant it, and I know you are a good person at heart, but re-read your post from the perspective of some of these women (and one guy) that have responded and you can see that your point of view is not much further from the annoying echoes and insensitive nagging most get at family reunions because they haven't provided a child for everyone else's edification.

God bless you and your child, and your attempt at a second. But don't forget to support, encourage, love and not judge those that simply have not, or may never, take the same path as you.

I would add that for a lot of women, having a baby in their twenties while still in school/training just isn't an option because they haven't found a life partner yet. Another issue would be if the SPOUSE of the woman desired a baby--and I don't know all that many men in their mid-late twenties, even those who are married, who are do-or-die about fatherhood.

In fact, I wonder if that isn't the majority of women in medicine now--anecdotally, it seems that most of my female classmates are not married or in serious relationships, or if they are, they are with men who do not desire to start a family.

I just throw that out there to say: Sometimes a woman doesn't even have the choice to have a baby young.

So everyone: Stop judging! Let each woman/family decide when it is 1) possible and 2) desirable to have a child! Obviously there are pros and cons on each side but there are no right or wrong answers!

I became a Mom at age 38. My husband and I had decided that we were not going to have children..partly because of career reasons, but also because our friends who had children early in their marriages complained to us non-stop about the "not joys" of being parents and continually told us how they envied us being "child-free". Then, when in our mid 30's, our friends who desperately wanted children, were unable to conceive, and adopted, began telling us about how wonderful being a parent was...we reconisdered. To those of you waiting and sweating out the fears of infertility..We were warned about how tough it might be to "get pregnant at my age". We were pregnant within 1 month of beginning to try. It can happen. My pregnancy was smooth and uneventful and I "bounced back" quickly (back at work in 1 week - we had a grant proposal to get out). And I had plenty of energy to get down and crawl around with my son.To Fizzy: You did what you needed to do because of your Mom's history of infertility. I felt completely comfortable waiting, because my Mom didn't marry until her mid 30's and had two children in her late 30's and I had an Aunt who had a "surprise" baby at age 42...she thought it was the beginning of Menopause until the obvious signs of pregnancy began.

I'd just like to point out that it's only within the last 90 years that women have even been able to realistically think about reproductive choice - as in when to reproduce, how many, how far in between each munchkin with the advent of birth control. And really we've only had that access to the full shmorgesborg for the last 40-60 years (and some still don't have complete access). So we no longer HAVE to have kids early, or at ALL if we so choose. Or we can postpone & probably with the assistance of technology, have a child later in life. The beauty of it is, we can choose each of us for ourselves – at least in most developed, forward thinking countries.

Being perplexed by women wanting to wait until they're established in the career seems a tad....for lack of a better word...ignorant (and no Fizzy, I don't think you're "ignorant", I've read your other posts, I just think maybe the semantics of the post are off). Yes there are fertility problems as you get older, but there are also many more options (costlier, but there nonetheless) to have kids as an older mom. Technology has improved in the last 18 years. We aren't stuck in some kind of technological void, where today's options are identically dismal as 1992's. Thus, it seems there is valid concern but in the same breath review the options. Older, more career stable women having kids have been proven to be better off socioeconomically speaking, than younger, unstable women.

I certainly felt pressure (everything from med school lectures to hearing IVF ads on the radio) to start working on a family soon after marrying my husband. I assumed it would be difficult and my mentor, whose struggle with infertility was very public, told me in no uncertain terms to not wait like she did.

We still waited a few years to feel "settled" and to enjoy our time together pre-babies and when the time came (still relatively young-31) I realized that one or both of us is insanely fertile.

There is a lot of pressure in our society for those of us who want a family and worry about not being able to, but I also can completely understand not being in the right place of one's life to start having children until later in one's career. I agree with other commenters that it is wonderful to have that choice!

As a second year married medical student I am happy to know there are others out there who feel the same way I do. I don't want to wait and risk it. I know some people do, but I don't and I appreciate you sharing a point of view that rarely gets shared. We hear all the time about people waiting so they can finish this or that, but in actuality there is no great time to have a baby....especially going into this career field.

I see that you've gotten some people that were a little upset with this post. Just know that the other side of that is comfort given to those of us who DON'T want to wait and are tired of being told we are crazy for that.

Wow, this post brought out many emotions from many people. Myself included. I am currently 47. Had my first child at 43, after many years of trying, infertility treatments, etc. It wasn't fun. However, I had a very easy pregnancy (which I felt I deserved after the years of trying and crying). We're even thinking of using some of our frozen embryos to try for #2. (Crazy, I know) However, I wouldn't trade my crazy 4 year old for anything. I didn't meet my husband until I was 34, we got married not long after that and didnt' really do anything to prevent pregnancy before that. Had several miscarriages.

I think Fizzy was trying to open eyes but it didn't unfortunately come across as "helpful" and many took it as hurtful, but I don't believe she meant it that way. This is one of the downsides of electronic communication.

Of course, I knew this post when generate a lot of comments... I was purposely saving it for my 100th to make a big bang :)

I really do apologize if anyone was hurt by the post, because that wasn't my intention. And yes, I do understand why. Having babies is emotional, waiting to have babies is emotional, and infertility is emotional. That is part of my point. I know that women in their 30s hear this from their friends, family, colleagues, etc, and then it gets to the point that any time they hear it, they want to punch the person who says it. I've gotten some of that pressure on #2, especially from my mother, so believe me that I understand.

But on the other hand, this is a story that was incredibly meaningful to me. I wasn't going to not share it because someone might get offended. If I'm going to work that way, I may as well stop blogging altogether. (Speaking of judgmental, there is absolutely NOBODY worse than internet mommies. If you don't have your crib facing, like, east, you're called a Nazi and an unfit mother.)

Obviously, it's a woman's choice whether to reproduce and when. I'm not making that choice for anyone. I thought people might be interested to hear why I made the specific decision I did, because I often felt like nobody understood. I do worry about infertility more than most women because of my family history, and it also makes me realize that reproductive technology isn't foolproof. I didn't want to miss my window, because it goes fast.

Fizzy-I found your description of your mother's angst heart-breaking. I can understand how that would influence your decision about when to start a family.

My own mother had 4 children, 2 in her mid-thirties. Her mother had a child at 36. My father's mother had him at 41. Infertility due to advanced maternal age was something that I never even considered when younger. I took it for granted that I'd be able to have children whenever I wanted.

I got married at 28 and was nowhere near ready to have children then. I had given up so much of my life to college & med school; I felt I needed some time for myself and my husband.

Once I was done with fellowship and in my early 30s, my biological clock started ticking suddenly, and loudly. I had my first child at 32. We had our 2nd child when I was a few months' shy of my 35th birthday. Both of my children were conceived within 2 months of trying. My husband is 10 years older than I am.

I did see friends who struggled, and continue to struggle, with infertility. I have come to realize how it's not always so easy as it would seem.

My sister, a lawyer, has an even crazier schedule than I. She's 30, in a new relationship, talking about having children when she's closer to 40. I, too, am a bit perplexed by her decision to wait that long....

My kids are terrific. I feel I am much better as an older mother. I am less neurotic, and my life as an attending physician allows me much more time with them than I would have had as a resident.

Yes, there probably is an optimal fertility window, but through my kids, I've gotten to know a large number of older, professional women who waited to have children...and were able to do so...and they're really awesome, wonderful moms.

We have been lucky enough to limit our ideas about why someone may or may not plan to conceive to "feeling ready." Just a reminder that some couples seem to wait to conceive because of invisible factors like miscarriages or spousal discord or abuse.

Wow, interesting discussion! Fizzy, I'm largely with you. In my professional world (academic, but not medicine), many couples wait. "Ideally" you would not only have a PhD, but also tenure before having your first baby. But that puts many people at 35 or even older. I took some time off before grad school so I didn't even get my first real job until I was 33.

We had our first a month after my 35th birthday and there was a certain amount of hoopla from the OB/GYN set because I had "advanced maternal age". I thought that was bogus because I was only advanced by a month. I got pregnant super easily and the pregnancy and delivery were a breeze. The baby was really hard so we waited three years to start trying again.

Then we had two miscarriages and a much more complicated pregnancy. I do sort of wish we hadn't waited. I wonder if it could have all been simpler if it had just been sooner.

I didn't have the pressure to "get started on a family" at all, since we had no real income. Thank goodness for my (male) advisor who told me that having a baby was a much bigger deal than anything that was happening professionally and that we should have children when we wanted them and figure out the career stuff around that choice. I don't think this was anti-woman at all. This advisor believes in my career more than anyone, sometimes more than me, but he is also a deeply committed father and I know he wouldn't want his students to miss out on parenthood because they waited too long.

I don't think Fizzy's post was at all anti-woman, but I do think our society has many structures in place that make it difficult for women to have children during the years when their bodies are best able to do so. I would advocate changing some of those structures. Why is it so often considered impossible to give someone 6-12 months off? Maybe even paid? Perhaps even while they are a student?

Wow Fizzy - happy I guess 100th! I was blissfully signing out coags, SIFEs, blood bank antibodies, livers and bone marrows and had NO IDEA you were in the trenches:)

I am bothered how the post reactions were so polar and focused on "taking sides." Why is there a side here? It is just one person making a decision based on her own experiences and projecting the angst she experienced growing up with her mother on colleagues around her who are waiting. I see that in no way as "judging" a decision. We all look at the world based on our own experiences and I agree with Tigermom above - there are lots of reasons that people wait that have nothing to do with career. But how can we see that if we aren't living in their shoes? So I'm with Fizzy here (hee hee just kidding). I'm with everyone. What a great discussion.

I started my family at 28, and the pressure I felt to have two babies close together nearly unhinged my sanity and certainly did irreparable damage to my marriage. Not that I blame everything on that decision, but it placed stresses on our relationship that led to events I am certain would not have happened otherwise. Hindsight is 20/20, and I've two great kids and no regrets. But we really have to admit to ourselves that sometimes we can't do it all, especially during the grueling years of training, unless we are well armed with a huge support network, which I wasn't.

One of my amazingly smart drop dead gorgeous partners had a baby three years ago at 47 after battling breast cancer. Her first two kids are post-college. Science (finally the Nobel Prize!) has awarded us many luxuries.

It was definitely a bonus of starting "early" that I was able to wait a lot longer before having a second. I would have been overwhelmed by having a second baby when my daughter was two years old.

I think depending on where people are in their lives, everyone is reading my post differently. Sort of like how when you read a book at age 20 it means different things to you than when you read it at age 30.

If I wanted to add another layer of polarization, I could write a post about how it's even harder to take time off for maternity leave AFTER residency is over. Having 20-30 residents to share coverage vs. 1-3 attendings.... just sayin'.

Wow, I'm just picking up this post now...quite the responses! Fizzy, I can understand the points you were TRYING to make, you just need to re-read your original post. Your comments come off as judgmental. Just sayin!!!!

I think people who are older and have not gotten started on babymaking are all reading the post as judgmental, mostly because they hear comments about "you better not wait" all the time and are sick of it.

But all I was trying to do was be honest and explain my real thought process. And I think I presented both sides, if YOU re-read it. I said that "the truth is, I'm sure they're all going to get pregnant. People seem to get pregnant pretty easily." That is what I think when I see my colleagues in their mid thirties still waiting. That they will probably get pregnant and that I am overly anxious (I even said that my husband thinks I'm silly). But I also wonder how they are brave enough to take that risk, because I wasn't. I also don't ride motorcycles or bunjee jump or smoke, and I don't know how people take those risks either. I am not a risk taker.

I was trying to be honest and tell the true story of my experience and what was going on in my head at the time. These are not judgments, but rather worries that I have. This was my stream of consciousness.

I think I presented both sides. But nobody wants to hear both sides. They only want to hear their own side.

Fizzy, I think you did well with your explanation. I took your "perplexed" in the same way that I'm "perplexed" by people who have great social skills. I realize they exist, they're clearly in the majority even, and it's not as if there's anything wrong with having great social skills.

It's just that I'm hardwired the direct opposite way; I even have trouble figuring out when the right time to say "Hi" after I get to the office is. So... yeah. I'm perplexed by those who take such ease in many interactions that really are quite a big deal for me.

The potential loss of fertility is a huge concern for you, especially given your past experiences. It's not that anyone's wrong for waiting to have a child; it's simply that when people are open about very much wanting children, you can't understand why they'd take the risk of their fertility not being there after a certain time period, because it's completely against your own "hardwiring" to be able to do that.

I don't think Fizzy's post is that bad. I think people just want to take it that way because they feel it's pointed at them. Goes along "guilty take the truth to be hard" saying a little bit. (10 bucks says that statement gets me flames, don't take it that way.) I do find it interesting that most of the people hurt by, or against the post are older and childless, and most of the people for the post are those with children, and younger. Yes, all you 30+ not having kids, you feel judged and pressured. To be honest I don't feel much sympathy for you. It's your choice, so deal with it and let people's criticisms rolls off your back. (Ok, I do have sympathy for those who may have other factors like having had multiple miscarriages, or a rocky-to-none relationship.) I know you think that's horrible for me to say. But look I married at 18 (gasp, I know) and had my daughter at 20. I get judged too, all the time. I just get the opposite end. People outright tell me I'm crazy and ask what was I thinking. I've been called irresponsible, and that there's no way I'll ever be a decent mother. People ask if it was a "mistake, and that's why I'm married young, and why didn't I just abort," they are also "perplexed" when I tell them no, it's planned and the marriage came first. At least when your older and not quite sure you want kids right now, people try to be delicate about it, and toe around the subject. When you are mistaken for a high schooler with a child, people don't tend to hold anything back. All Fizzy's saying is that it's a gamble to try later, you choose what odds you want to play. She chose to play earlier, when the odds are slightly better, as did I. It's a gamble either way folks, kids can still lose their babies even if they're in the 20s and doing everything right. The odds just go down and time goes on. And yes, most people will win, but some won't.

Thanks for your comment, Brit. It's a shame people are always judging us women for our choices, when it's clearly none of anyone's business but our own. I felt judged for having a baby as early as 27, so I can only imagine what you went through.

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